La régulation contractuelle : l’exemple de la biologie de ville

Résumé En

Contractual Regulation : the Example of the Non-Hospital Sector Contractual regulation of health care outside the hospital sector was introduced in 1991 folio wing an overly brutal revision of the remuneration scale. This System of regulation created a three-way relationship between the State, the health insurance and professionals in the making of an annual agreement forecasting future health service expenditure. The basic idea behind contractual regulation is co-responsibility. The financial framework sets out the predicted increase in treatments with an adjustment mechanism operating a rigid System of financial compensation. This is accompanied by recommendations and the creation of means for gathering information conceming the sector. All the objectives which were forecast have been reached, but management of the System is complex. Specific negociation with each profession brings with it a risk of inflexibility in parts of the market. The means of putting the national objective into effect at regional level still has to be worked out. Beyong this it appears that contractualisation has its limits due to the over-protective effect of the contract which prevents spontaneous increases in spending which might be a lot less favourable for professionals. In fact what this method of contractualisation lacks is the State’s vision of the aim sought to be achieved.